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Breast Cancer Research and Treatment

, Volume 178, Issue 2, pp 469–471 | Cite as

Rationale for evaluating breast cancers of Lynch syndrome patients for mismatch repair gene expression

  • Steven SorscherEmail author
Brief Report

Abstract

Background

Lynch Syndrome (LS) patients harbor germline mutations in one of several mismatch repair (MMR) genes and are predisposed to the development of colon and endometrial cancers and multiple other cancers types as well. Tumors related to LS are characterized by deficient protein expression of one or more MMR genes (dMMR) and/or demonstrate high microsatellite instability (MSI-H) (Win et al. in Breast Cancer Res 15(2):R27, 2013). The National Comprehensive Cancer Network (NCCN) Guideline states that there have been “suggestions” of increased risk of breast cancer in diagnosed LS patients, but does not endorse “increased screening above-average-risk breast cancer screening recommendations” for patients with LS (Provenzale et al. in J Natl Compr Cancer Netw 14(8):1010–1030, 2019).

Results

This report describes a molecularly diagnosed LS patient who developed a dMMR breast cancer.

Conclusions

Sporadic dMMR breast cancers are extremely rare (Davies et al. in Cancer Res 77:4755–4762, 2017). It seems reasonable to conclude that identifying a dMMR breast cancer in a patient with known LS strongly suggests that her LS is breast cancer-predisposing. LS patients with dMMR breast cancers might therefore be considered for above-average breast cancer screening for the development of additional breast cancers. Also, the FDA recently granted approval of checkpoint inhibitor therapy for all metastatic dMMR solid malignancies (Lemery et al. in N Engl J Med 377:1409–1412, 2017). MMR expression assays in metastatic breast cancers of LS patients would represent a more focused approach to identifying patients with breast cancers who are potentially eligible for checkpoint inhibitor therapy than would be universal MMR testing of all metastatic breast cancers.

Keywords

Lynch syndrome Breast cancer Mismatch repair 

Notes

Funding

There was no funding for this study.

Compliance with ethical standards

Conflict of interest

Dr. Sorscher has received no research grants. Dr. Sorscher has received speaker honoraria from Celgene Corporation, Pfizer Pharmaceuticals, and Puma Biotechnology. Dr. Sorscher owns no stock that would constitute a potential conflict of interest.

Informed consent

Written informed consent was obtained from the single individual referred to in the study, and all procedures involved with the single individual were in accordance with the ethical standards of the institution where the patient received her care.

References

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    Davies H, Morganella S, Purdie CA et al (2017) Whole genome sequencing reveals breast cancers with mismatch repair deficiency. Cancer Res 77:4755–4762CrossRefPubMedGoogle Scholar
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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Oncology DivisionWake Forest School of MedicineWinston-SalemUSA

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